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The Petition Against DSM 5 Gets Off To Fast Start

Just a few days ago, the American Psychological Association posted a well crafted open letter spelling out the many risks posed by DSM 5 and inviting mental health professionals to sign a petition requesting much needed changes in both the DSM 5 product and process. You can see the letter and (if you agree with it) sign the petition at http://www.ipetitions.com/petition/dsm5/

The posting was done in a singularly obscure way- on a weekend, with no press release, no facebook, no twitter, no promotion at all. Remarkably, more than a than a thousand mental health professionals have already found the site and signed the petition - and the numbers are increasing steadily.

It is far too early to predict how many people will eventually sign on and what impact, if any, the petition will have on APA. I have heard that the APA and DSM 5 leadership are aware of the letter and petition, but plan no formal response. They hope to ride out the storm of opposition mounting on all sides(detailed in a previous blog) and dismiss it as the work of professional rivals or antipsychiatry malcontents. Characteristically, DSM 5 offers no rebuttal based on evidence. Instead, it stubbornly soldiers on in its promotion of radical diagnostic changes that are risky, untested, unsupported by a strong science base, and vigorously opposed by the field.

Let's be clear. The general opposition to DSM 5 is simply that- opposition to DSM 5, not to psychiatry. Hiding behind the excuse that critics are impugning psychiatry because they are afraid of DSM 5 just wont cut it. Sure there are some in the antipsychiatry crowd enjoying this sad fiasco, but they are a tiny minority and their existence should not warrant giving DSM 5 immunity from the criticism it so justly deserves.

The really unexplainable paradox is APA's systematic promotion of greater diagnostic inflation at a time when we are already so obviously plagued by diagnostic inflation, fad diagnosis, and false epidemics. Unless it comes to its senses, DSM 5 will promote greater drug use when exactly at a time when inappropriately loose prescriptions of antipsychotics, antidepressants, antianxiety agents, pain medicines, and stimulants is already a public health problem. The paradox is that, contrary to conspiracy theorists, the DSM 5 experts are not making their risky suggestions because of financial conflict of interest or the desire to line drug company pockets. They have the best of intentions, but are terminally naïve about how their suggestions will be misused.

Can anything force APA to produce a safe DSM 5? Probably only one thing- a massive buyers' revolt. Tens of thousands of people signing the petition will get the attention that reasoned argument has so far filled to attract. Given the fast start, the petition has a fair chance of snowballing and becoming a game changer- but only time will tell.

In reading the petition, I had a sense of a lack of historical memory. In 1977, there was a presentation by Robert Spitzer and Jean Endicott on defining "mental disorder" that defined "medical disorder" and claimed that "mental disorder" was a subset of that. Their goal to to challenge critiques about psychiatry not being a legitimate branch of medicine, but it created quite a reaction among psychologists who feared that the APA was doing turf-warfare, trying to get a bigger slice of the mental-health-funding pie. As a result, the "subset of medical disorders" language was not included in DSM-III and Spitzer had to write an editorial for the APA Monitor to alleviate the fears of concerned psychologists.

Thirty years later, the DSM-5 people seem to be doing the same thing, but the fact is that physicians make up a small portion of the mental health professionals who use the DSM. Fears of turf wars remain, and one gets the suspicion that the DSM-5 folk aren't really all that sensitive to the political/guild concerns of those other guilds that use their book...